Serious Game Improves Emergency Triage for Seniors

Emergency physicians who use a specialized video game to practice trauma triage are more effective at identifying and treating severely injured older adults than those who receive standard education.

The findings, published April 20 in JAMA, suggest that a theory-based serious game—a purpose-driven video game—can improve physician adherence to life-saving triage guidelines.

The tool was developed by a team of surgeon-scientists from UPMC and the University of Pittsburgh. It is designed to serve as an effective alternative to recertification courses, which are often costly and time-consuming.

The Challenge of Triage for Older Adults

Trauma triage requires doctors to make split-second decisions. They must rapidly synthesize all available information about a patient and their injuries, then apply medical knowledge to determine the appropriate level of care.

Depending on the triage decision, a patient might be placed on a medical helicopter for transfer to a hospital with greater resources and trauma expertise. Conversely, a patient may be determined to be stable enough to be discharged to recover at home.

However, older adults are frequently undertriaged, meaning they are not assigned a level of care that matches the severity of their injuries. According to the research, older adults are undertriaged as much as 70% of the time.

Deepika Mohan, a trauma surgeon at UPMC and associate professor of surgery and of critical care medicine at Pitt’s School of Medicine, served as the lead author of the study. She noted that a growing number of seriously injured patients are older than 65.

Mohan explained that these patients are often undertriaged because their injuries are more insidious.

People may not think a rib fracture is a big deal. But if an older person falls and suffers four rib fractures, their risk of dying is the same as a young person shot in the liver.

Deepika Mohan

Improving Clinical Decision-Making

The development of the serious game was driven by Mohan’s professional experiences in the emergency department. She described a frustrating pattern of consulting on patients who did not actually require her level of expertise, while simultaneously seeing other patients who were undertriaged and suffered long delays before being transferred to a trauma center for appropriate care.

By simulating these high-pressure scenarios, the video game allows physicians to practice the cognitive process of triage. This training helps doctors better recognize the subtle markers of severe injury in older populations that might otherwise be overlooked during a standard assessment.

The study indicates that this interactive approach outperforms traditional education methods in improving the accuracy of care for severely injured seniors. By increasing adherence to established triage guidelines, the tool aims to reduce the incidence of delayed care and improve patient outcomes in emergency settings.